Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Department of Pediatric Cardiology and Cardiothoracic Surgery, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr. 2019 Dec;215:75-82.e2. doi: 10.1016/j.jpeds.2019.07.017. Epub 2019 Aug 23.
To determine prevalence and risk factors for brain injury in infants with critical congenital heart disease (CHD) from 2 sites with different practice approaches who were scanned clinically.
Prospective, longitudinal cohort study (2016-2017) performed at Hospital for Sick Children Toronto (HSC) and Wilhelmina Children's Hospital Utrecht (WKZ), including 124 infants with cardiac surgery ≤60 days (HSC = 77; WKZ = 47). Magnetic resonance imaging was performed per clinical protocol, preoperatively (n = 100) and postoperatively (n = 120). Images were reviewed for multifocal (watershed, white matter injury) and focal ischemic injury (stroke, single white matter lesion).
The prevalence of ischemic injury was 69% at HSC and 60% at WKZ (P = .20). Preoperative multifocal injury was associated with low cardiac output syndrome (OR, 4.6), which was equally present at HSC and WKZ (20% vs 28%; P = .38). Compared with WKZ, HSC had a higher prevalence of balloon-atrioseptostomy in transposition of the great arteries (83% vs 53%; P = .01) and more frequent preoperative focal injury (27% vs 6%; P = .06). Postoperatively, 30% of new multifocal injury could be attributed to postoperative low cardiac output syndrome, which was equally present at HSC and WKZ (38% vs 28%; P = .33). Postoperative focal injury was associated with intraoperative selective cerebral perfusion in CHD with arch obstruction at both sites (OR, 2.7). Compared with HSC, WKZ had more arch obstructions (62% vs 35%; P < .01) and a higher prevalence of new focal injury (36% vs 16%; P = .01).
Brain injury is common in clinical cohorts of infants with critical CHD and related to practice approaches. This study confirms that the high prevalence of brain injury in critical CHD is a clinical concern and does not simply reflect the inclusion criteria of published research studies.
确定来自 2 个具有不同实践方法的地点的接受临床扫描的危重症先天性心脏病（CHD）婴儿中脑损伤的发生率和危险因素。
前瞻性纵向队列研究（2016-2017 年），在多伦多 Sick Children 医院（HSC）和乌得勒支 Wilhelmina 儿童医院（WKZ）进行，包括 124 例心脏手术后≤60 天的婴儿（HSC=77；WKZ=47）。根据临床方案，对所有婴儿进行术前（n=100）和术后（n=120）磁共振成像检查。对多灶性（分水岭、白质损伤）和局灶性缺血性损伤（中风、单一白质病变）的图像进行了回顾性分析。
HSC 的缺血性损伤发生率为 69%，WKZ 为 60%（P=0.20）。术前多灶性损伤与低心输出量综合征相关（OR，4.6），HSC 和 WKZ 均有此表现（20%比 28%；P=0.38）。与 WKZ 相比，HSC 大动脉转位中球囊房间隔造口术的发生率更高（83%比 53%；P=0.01），且术前局灶性损伤更为常见（27%比 6%；P=0.06）。术后，30%的新发多灶性损伤可归因于术后低心输出量综合征，HSC 和 WKZ 均有此表现（38%比 28%；P=0.33）。术后局灶性损伤与 2 个部位 CHD 弓部梗阻时的术中选择性脑灌注有关（OR，2.7）。与 HSC 相比，WKZ 的弓部梗阻更多（62%比 35%；P<0.01），新发局灶性损伤的发生率更高（36%比 16%；P=0.01）。
危重症 CHD 婴儿的脑损伤很常见，且与实践方法有关。本研究证实，危重症 CHD 中脑损伤的高发生率是一个临床问题，而不仅仅反映了已发表研究的纳入标准。
